Healthcare algorithm for lumbar spinal stenosis

Feeling under the weather and had to stay home from work.

Taking the opportunity to play catch up on some of the articles that I have piling up.

This article is well written and I learned something within the first couple of pages, which is always great.

We see clinical presentations of Lumbar Spinal Stenosis on the daily, but I didn’t realize that there were three separate classifications of LSS.

This is a great algorithm, depending on perspective. For instance, as a PT, rehab measures are highlighted as the second step of evaluation/intervention. I’m good with that. I always believe that self-management, assuming the patient has some semblance of competence, should be step one.

As a surgeon, I could see how this may or may not be your cup of tea.

For those that aren’t busy enough, I could see understand the opinion below of wasting time to get to surgery because the patient may end up there anyway.

I fully understand the second surgeon saying that these types of algorithms would be very useful to minimize unwarranted referrals to surgeons.

It’s interesting to me to see the generational separation between the two opinions also.

I’m curious if these opinions are inherent, based on experience, evidence, based on self-preservation or based on the patient’s needs.

The third statement is more clear to me now than it was while I was in private practice.

For instance, I would get a patient in for an evaluation within 24 hours if needed. I was the manager and stood to gain the most by having more patients on our census than say the other clinicians. The business also stood to make more profit, which would trickle down to me.

Also, in private practice there is always the belief that there is a finite number of patients walking through the door, so “make hay while the sun’s out”.

In a large corporate setting, HOPTS, and some POPTS, there’s a large waiting list. These patients may have to wait weeks or months to see a provider. In the meantime, they are waiting to enter the algorithm. I can understand how one physician sees this as a waste of time. A patient sitting for weeks at home without care, but wants care, is something that I struggle with now that I am no longer running the show.

Overall, good to see differing opinions and how the algorithm proposes to manage LSS.

Comer C, Ammendolia C, Battie M et al. BMC Muskuloskeletal Disorders. (2022) 23:550

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